Cem Cerit

Stigma: a core factor on predicting functionality in bipolar disorder.

OBJECTIVE Extant literature indicates that bipolar disorder (BD) is associated with significant poor psychosocial functioning. However, the relationship between functioning and demographic and clinical variables is unclear. The aim of this study is to investigate the predictors of functioning such as demographic and clinical variables, social support, self-perceived stigma, and insight in remitted patients with BD. METHODS Eighty patients with a diagnosis of BD, complete remission according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were included in the final assessment. Bipolar Disorder Functioning Questionnaire, Beck Depression Inventory, Young Mania Rating Scale, Internalized Stigma of Mental Illness Scale, Multidimensional Scale of Perceived Social Support, and Schedule for Assessing the Three Components of Insight were used. Student t test, Pearson correlation analyses, and linear regression analyses were used to assess the pathways effecting on functioning. RESULTS The 3 predictors of functioning were severity of depression, perceived social support, and internalized stigmatization. Severity of depression is considered the strongest predictor, whereas internalized stigmatization has a core role in predicting functioning. Clinical variables such as years of education and number of hospitalization probably have indirect effects on functioning. CONCLUSION Interventions that oppose stigmatization and consideration of mild depressive symptoms will positively affect functioning in remitted patients with BD.

Brain mast cells and therapeutic potential of vasoactive intestinal peptide in a Parkinson's disease model in rats: brain microdialysis, behavior, and microscopy.

In the present study, the effect of systemically administered vasoactive intestinal peptide (VIP) (25 ng/kg i.p.) was investigated on drug-induced rotational behavior, extra-cellular dopamine levels and histology of corpus striatum in a 6-hydroxydopamine (6-OHDA)-induced rat model of Parkinsons disease. After 15 days of 6-OHDA lesion, apomorphine-induced (0.05 mg/kg s.c.) rotational behavior of the animals significantly increased and extra-cellular dopamine levels of corpus striatum were significantly reduced. VIP reversed the rotational deficits but did not alter the decrease in striatal dopamine levels. On the other hand, histological data indicate that VIP significantly reduced neuronal death and demyelination. Electron microscopic appearance of mast cells showed ultra-structural variety between VIP-treated and 6-OHDA lesioned groups. VIP activates mast cells without any evidence of typical exocytosis, and possibly mast cells could participate in neuroprotection. Our results suggest that systemically administered VIP can attenuate the motor response changes, neuronal cell death, and myelin sheet loss characteristically associated with 12 microg 6-OHDA administration into the rat striatum. Brain mast cells seem to participate in neuronal protection. Possibly, protective cues could be produced by brain mast cells.

Delusional parasitosis with hyperthyroidism in an elderly woman: a case report

IntroductionDelusional parasitosis is a rare, monosymptomatic psychosis involving a delusion of being infested with parasites. It is commonly observed among female patients over the age of 50. It is classified as a ‘delusional disorder’ according to the 10th revision of the International Classification of Diseases and as a ‘delusional disorder - somatic type’ according to the Diagnostic and Statistical Manual, Fourth Edition. Delusional parasitosis was reported to be associated with physical disorders such as hypoparathyroidism, Huntington’s chorea and Alzheimer’s disease, among others. Other than vitamin deficiencies however, a causal relationship has not to date been identified. We present this case due to the rarity of Turkish patients with this condition, its duration of follow-up, and its temporal pattern of symptoms paralleling thyroid function tests.Case presentationOur patient was a 70-year-old white Anatolian Turkish woman with primary school education who had been living alone for the past five years. She presented to our psychiatry department complaining of ‘feeling large worms moving in her body’. The complaints started after she was diagnosed with hyperthyroidism, increased when she did not use her thyroid medications and remitted when she was compliant with treatment. She was treated with pimozide 2mg/day for 20 months and followed-up without any antipsychotic treatment for an additional nine months. At her last examination, she was euthyroid, not receiving antipsychotics and was not having any delusions.ConclusionAlthough endocrine disorders, including hyperthyroidism, are listed among the etiological factors contributing to secondary delusional parasitosis, as far as we are aware this is the first case demonstrating a temporal pattern of thyroid hyperfunction and delusions through a protracted period of follow-up. It may be that the treatment of delusional parasitosis depends on clarifying the etiology and that atypical antipsychotics may help in the management of primary delusional parasitosis. Further studies on the relationship between thyroid hormones and dopaminergic neurotransmission may be warranted.

D-Cycloserine acts via increasing the GluN1 protein expressions in the frontal cortex and decreases the avoidance and risk assessment behaviors in a rat traumatic stress model.

D-cycloserine (DCS), an FDA approved anti-tuberculosis drug has extensively been studied for its cognitive enhancer effects in psychiatric disorders. DCS may enhance the effects of fear extinction trainings in animals during exposure therapy and hence we investigated the effects of DCS on distinct behavioral parameters in a predator odor stress model and tested the optimal duration for repeated daily administrations of the agent. Cat fur odor blocks were used to produce stress and avoidance and risk assessment behavioral parameters were used where DCS or saline were used as treatments in adjunct to extinction trainings. We observed that DCS facilitated extinction training by providing further extinction of avoidance responses, risk assessment behaviors and increased the contact with the cue in a setting where DCS was administered before extinction trainings for 3 days without producing a significant tolerance. In amygdala and hippocampus, GluN1 protein expressions decreased 72h after the fear conditioning in the traumatic stress group suggesting a possible down-regulation of NMDARs. We observed that extinction learning increased GluN1 proteins both in the amygdaloid complex and the dorsal hippocampus of the rats receiving extinction training or extinction training with DCS. Our findings also indicate that DCS with extinction training increased GluN1 protein levels in the frontal cortex. We may suggest that action of DCS relies on enhancement of the consolidation of fear extinction in the frontal cortex.

Discerning the effects of psychopathology and antidepressant treatment on sexual dsyfunction

Abstract Objective. To compare the frequency and correlates of sexual dysfunction in patients with Major Depressive Disorder on SSRI treatment with those who are not. Methods. Patients diagnosed with Major Depressive Disorder, without comorbid psychopathology/medical disorder/alcohol/nicotine use for the past year with a CGI-S severity score of 4 were included. Two groups were formed, one using SSRIs at least for 6 weeks before the study, and another who were free of drugs for the last month. Arizona Sexual Experience Scale (ASEX) was given to determine sexual dysfunction. P was set at 0.05. Results. Thirty-three patients (25 female, 75.8%) were included. The study group was using sertraline (n = 10, 52.6%) and citalopram (n = 9, 47.4%). Fourteen patients on SSRIs (73.7%) and 12 controls (% 85.7) displayed sexual dysfunction with no difference between groups. Female gender was associated with sexual dysfunction, regardless of treatment (P = 0.04). Arousal sub-test of ASEX differed significantly in the group with dysfunction (P = 0.04). Conclusions. Female gender may be a risk factor for sexual dysfunction in the presence of depression, regardless of drug use. Arousal may be affected in patients, regardless of treatment, and this may reflect the effect of depressive cognitions on libido.

Agomelatine versus Sertraline: An Observational, Open-labeled and 12 Weeks Follow-up Study on Efficacy and Tolerability.

Objective In this open-labeled, 12 weeks follow-up study, we aimed to compare the efficacy and tolerability of agomelatine with sertraline Methods The outpatients of adult psychiatry clinic who have a new onset of depression and diagnosed as ‘major depressive episode’ by clinician according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition and prescribed agomelatine (25 mg/day) or sertraline (50 mg/day) were included in the study. Results The decline of mean Montgomery-Asberg Depression Rating Scale (MADRS) scores of agomelatine group was significantly higher than the sertraline group at the end of 2nd week; however, the difference was not significant at the end of 3 months. Mean Clinical Global Impression-Improvement scale (CGI-I) scores of agomelatine group was lower than sertraline group at first week. Mean CGI-Severity scale and CGI-I scores were favour to sertraline group at the end of the study. Remission rates were 46.7% for sertraline group and 33.3% for agomelatine group while response rates were 76.7% for both groups. Any patient from agomelatine group dropped-out due to adverse effects. The amount of side effects was also less with agomelatine. Conclusion Agomelatine has a rapid onset efficacy on depressive symptoms and this can be beneficial for some critical cases. Considering MADRS scores, agomelatine seems to have similar efficacy with sertraline but we also point the need for long term studies since CGI scores were favour to sertraline group at the end of the study. Agomelatine has a favourable tolerability profile both in terms of discontinuation and the amount of side effects compared to sertraline.

Comparison of the effects of sertraline and agomelatine on sleep quality, sexual functioning and metabolic parameters in patients with major depressive disorder

ABSTRACT OBJECTIVE: This research aims to compare the effects of sertraline and agomelatine on outpatients diagnosed with a “major depressive episode” in terms of sleep quality, sexual functioning, and metabolic parameters related to metabolic syndrome. METHODS: This observational, open-labelled, 12-week follow-up study was carried out in the outpatient psychiatry clinic of a state research hospital. Included in the study were 60 outpatients admitted to the adult psychiatry clinic diagnosed with a “major depressive episode” who were subsequently prescribed agomelatine (25 mg/day) or sertraline (50 mg/day). Arizona Sexual Experience Scale (ASEX) and Pittsburgh Sleep Quality Index (PSQI) were performed during the 1st, 2nd, 4th, 8th and 12th weeks of treatment. The metabolic parameters; Body Mass Index, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, liver enzymes (Alanine transaminase (ALT), Aspartate transaminase (AST) and lipid profiles – total cholesterol and total triglycerides, low density lipoprotein (LDL), high density lipoprotein and very low density lipoprotein – were assessed after the first interview (pre-treatment) and in the 12th week of treatment (post-treatment). RESULTS: The PSQI scores of both the sertraline and agomelatine groups had declined significantly by the end of the follow-up, with the decline in PSQI scores in the agomelatine group being higher than the decline in the sertraline group. The decline in the ASEX scores of the sertraline group was not significant, while the score was significant in the agomelatine group at the end of the follow-up. However, the difference in the changes in the ASEX scores between the study groups was not significant. The unfavourable changes noted in metabolic parameters were: elevation of the mean LDL level in patients using sertraline, and an elevation in liver enzymes (AST and ALT) in the patients using agomelatine. CONCLUSION: The favourable effects of agomelatine on sleep quality and the rapid onset of this effect may be beneficial in particular cases. Agomelatine may be an alternative drug for patients who complain of sexual side effects. Clinicians should evaluate the lipid profile of patients using sertraline, while liver function should be monitored in patients using agomelatine. Neither treatment led to unfavourable outcomes on most of the metabolic parameters.

Post-traumatic stress disorder among mothers whose children underwent oncological surgery

The aim of this study was to investigate the rate of post‐traumatic stress disorder (PTSD) and associated risk factors among mothers of children who underwent cancer surgery.

Social Aspect of Functioning Deteriorates More Than Individual Aspect in Patients with Remitted Bipolar Disorder

INTRODUCTION Many studies have demonstrated that patients with bipolar disorder (BD) suffer from significant functional impairment, even during remission periods. This study aimed to assess the levels of overall functioning and specific areas of functioning in remitted patients with BD compared with those in healthy controls. METHODS Eighty completely remitted patients with BD and 80 healthy controls were included in the study. The Bipolar Disorder Functioning Questionnaire (BDFQ), Young Mania Rating Scale, and Beck Depression Inventory were used. RESULTS There were fewer married and employed cohorts in the BD group than in the control group. Compared with healthy controls, patients with BD exhibited a worse functioning in terms of intellectual and sexual functioning, feelings of stigmatization, social withdrawal, household relationships, relationships with friends, and participation in social activities. There was no difference between the groups in terms of emotional functioning, daily activities and hobbies, taking initiative and self-sufficiency, and occupation. The total BDFQ scores of patients were lower than those of healthy controls. A better functionality was observed in patients using only a mood stabilizer than in patients using three or more drugs. CONCLUSION Remarkably, remitted patients with BD tended to perform daily activities well when these activities were not in a social context. Stigma-oriented interpersonal approaches can be particularly beneficial for these patients.